Self-injurious behavior in anorexia nervosa

Recent reports have postulated the existence of two different types of self -injurious behavior: impulsive and compulsive. The aim of the present study is to analyze the dimensionality of self-injurious behavior and to study t he link between self-injurious behavior and clinical features in anorexia n ervosa. The study involved 236 consecutive patients with anorexia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistr uctured interview and self-reported questionnaires, such as the Eating Diso rders Inventory and Hopkins Symptom Checklist. A principal component analys is was used to study the dimensionality of different types of self-injuriou s behavior, including purging. Our findings confirm the distinction between impulsive and compulsive self-injurious behavior. The dimensions appear to be represented as a continuum in both the anorexia nervosa diagnostic subg roups. A third distinct dimension emerged that; included self-induced vomit ing and laxative/diuretics abuse. Childhood sexual abuse and anxiety signif icantly predict the presence of impulsive self-injury, whereas obsessionali ty and age predict compulsive self-injury. The coexistence of a positive sc ore on both dimensions of self-injurious behavior was the strongest predict or of treatment dropout. The present study highlights the importance of sel f-injurious behavior; it should be given due consideration in future outcom e studies on anorexia nervosa.